Safeguarding adults at risk

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Form instructions

What will I need to complete this form?
You will be required to create a portal account, or log in to an existing account, in order to complete and submit the form.

If there is immediate danger to life, risk of injury or if a crime is being committed, dial 999.

This portal is for adult safeguarding referrals ONLY. Please provide as many details as possible about the situation. Please describe:

  • Details of the allegation
  • When and where it happened
  • What type of abuse is suspected
  • Primary support needs
  • If anyone else was involved
  • Details of risks
  • Any actions that have been taken
  • If there are any desired outcomes
  • Do they have capacity

* The red star/asterisk symbol indicates that the question is mandatory and must be answered in order to continue.
How long will it take?
The form will take 10-15 minutes to complete depending on the amount of information you need to provide. Please be aware that for security reasons your session will timeout after 30 minutes of inactivity.

Please save your form regularly using the 'Save for Later' button at the bottom of the screen. The form will then be available for 90 days in your list of My Saved Forms.
Viewing, printing and saving a copy of the form
Once you have submitted the form you will be able to see a copy of it in My Submitted Forms (at the top of the screen). This will be available for 90 days. After 90 days the form will no longer be visible. We recommend that you print or save a copy locally. To do this select the one you want, from My Submitted Forms, and open it. Then you can print or save it.
How to update the form if Adult Care Services require more information
There may be times that we ask you for more information. We will not progress this referral until you re-submit the form with the extra information.

You will receive an email asking for further information. You can click on the link in the email or go to My Submitted Forms section of the portal. The Forms requesting more information section will be at the top.

The missing information details will be under Comments, including the name of the referred adult. Open the form by clicking on the link on the left under Form. You can update most of the questions (except name, Date of Birth and address) and re-submit it.
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